Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Montana for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Montana only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Montana (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Consumer Direct District Of Columbia (NPI 1619334323)

Field	Value
Entity Type	Organization
Organization	Consumer Direct District Of Columbia
Address	125 Bank St Ste 200
City	Missoula
State	MT
ZIP	59802
Taxonomy	In Home Supportive Care Agency
NPI Enumerated	January 26, 2016

Payer Source	Total Paid
Medicaid	$393.2M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and is effectively a single‑payer (Medicaid) operation by scale: total Medicaid revenue is $393.2M and there is no recorded Medicare revenue. Analysts should treat Medicaid as the primary and only visible payer when assessing financial and utilization trends for this entity.

Medicaid revenue is extremely concentrated: the precomputed top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with T1019 alone reported at $393.2M (100.0% of this provider's Medicaid revenue). This concentration indicates that almost all Medicaid dollars flow through a narrow set of service codes rather than a diversified fee mix.

The code mix and taxonomy are consistent: the provider is listed as an In Home Supportive Care Agency and T1019 (personal care services, per 15 minutes, part of an individualized plan) accounts for 1.9M claims at a $206 avg paid/claim. This pattern supports an operational model centered on high‑volume, minute‑based personal care delivered in home/community settings rather than episodic medical services.

T1019 is a statewide outlier: the code ranks #1 of 38 providers in-state and is flagged as an "extreme outlier, far above typical state volume for this code." That ranking signals this provider is a dominant player in Montana for personal care services and should be a primary comparator when payers evaluate network concentration or provider impact for this benefit.

Ancillary and administrative codes contribute negligible revenue: G9001 shows 374 claims and $59.5K revenue (ranks #1 of 1 providers in-state, with a note of 0th percentile/no peer comparison), while T2040 shows 7.7K claims but $0 revenue (ranks #1 of 2 providers in-state, described as typical/unremarkable). Multiple additional listed codes show claims with $0 avg paid/claim and $0 revenue, indicating either non‑reimbursed administrative filings or state reporting artifacts that do not materially affect revenue.

The sheer claim volume for the dominant code implies substantial operational scale: 1.9M T1019 claims at a $206 avg paid suggests a large caregiver workforce and significant scheduling/authorization infrastructure to support minute‑based billing. Payers and competitors should expect this provider to have established processes for high‑throughput personal care delivery.

Concentration in a single service line creates financial and contracting sensitivity: because virtually all Medicaid revenue is tied to T1019 (and the top 3 codes together are listed as 100.0% of revenue), changes to policy, reimbursement rates, or utilization management for personal care services would disproportionately affect this provider's revenue and payer negotiations. Monitoring state policy and reimbursement trends for T1019 should be prioritized.

The provider has an active NPI enumerated on 2016-01-26 (~10 years ago), indicating an established presence in the market. Combined with the high volumes and statewide ranking, the tenure supports classifying this entity as an entrenched Medicaid personal‑care operator in Montana rather than a new entrant.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	1,908,640	$210	$393.2M
G9001	Coordinated care fee, initial rate	370	$160	$59.5K
0001	N/A	530	$0	$0
0003	N/A	50	$0	$0
2001	N/A	30	$0	$0
2002	N/A	10	$0	$0
2003	N/A	30	$0	$0
T2040	Financial management, self-directed, waiver; per 15 minutes	7,670	$0	$0

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.

Claims Volume vs. Montana Distribution

Consumer Direct District Of Columbia — 1 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	1	40	6,240	$130	$14.6M
T2040	Financial management, self-directed, waiver; per 15 minutes	1	10	4,270	$20	$77.6K
G9001	Coordinated care fee, initial rate	1	10	370	$160	$59.5K
0001	N/A	1	10	530	$0	$0
0003	N/A	1	10	50	$0	$0
2001	N/A	1	10	30	$0	$0
2002	N/A	1	10	10	$0	$0
2003	N/A	1	10	30	$0	$0

Nearby Providers

Other providers in the same ZIP code as Consumer Direct District Of Columbia, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Youth Homes	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$9.7M
Western Montana Clinic PC	MT	Multi-Specialty Clinic/Center	$0	$8.7M
Providence Health & Services Mt	MT	Emergency Medicine Physician	$0	$8.2M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$5.7M
Providence Surgery Center	MT	Ambulatory Surgical Clinic/Center	$1.6M	$3.5M
Partnership For Children	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$4.7M
Gary Wingfield	MT	Assisted Living Facility	$0	$4.7M
Providence Health & Services Mt	MT	General Acute Care Hospital	$0	$2.4M
Western Montana Clinic PC	MT	Clinical Medical Laboratory	$668.9K	$1.7M
Melody Nelsen	MT	Rheumatology Physician	$2M	$0

Consumer Direct District Of Columbia — Billing Profile & Reimbursement Data

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Consumer Direct District Of Columbia — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References